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This is somewhat a follow up from Defibrillating Health.SE.

Until now, we have tried to set up a new site „MedicalSciences.SE“. The process of this isn’t all too far, we‘re still lacking quite a few supporters and good questions to get out of the definition phase.

I’ve had a chat with a mod on CognitiveSciences.SE. A year ago, they realised they have a few problems on the site:

  • small user base of professionals
  • many bad questions

Sounds a bit familiar, eh? They have thought of options and decided to essentially reboot the site: Creating custom close reasons (one we have already: Personal Medical Advice should be closed, the other one is basically a group of all bad questions present in the site) and a huge spring cleaning where everything that was unwanted was flagged, closed and deleted.

Since then, their site has been slowly regrowing the user base, and quality increases.

They have decided against the whole Area51 because they thought that was hopeless.

I wonder if we can learn something from their experience.

Because chat is difficult to organise and get everyone to participate, I've switched plans and would prefer a discussion going on here. To give everybody a sense of what I'm hoping to achieve, I've posted some example questions below and my personal opinion as an answer.

Example Questions

Which aspects of Health.SE are working well?

Which aspects of Health.SE should be improved, and how?

What do you think of the site name?

What do you think of the site moderation?

What do you think of how we handle the need of references?

What do you think of the scope?

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    I'm curious what is the expected benefit of a live chat vs. a posting on Meta. Maybe you can get enough people that used to be involved, but it seems unlikely. My participation will depend entirely on my IRL schedule, which is exceedingly hard to predict more than 72h in advance. – Atl LED Nov 10 '17 at 16:00
  • @AtlLED Because conversations and debates tend to be more engaging in chat. But I‘ll think about it, maybe I’ll change the format. – Narusan Nov 10 '17 at 16:01
  • I'm not saying not to do it. If I'm free for whenever this is around, and honestly if I remember, I'll try to make it. I feel like I already documented what I had to say clearly on H.Meta, it wasn't accepted, and there's little else to say. – Atl LED Nov 10 '17 at 16:04
  • @AtlLED I do think you have a point though. I've updated the question and posted my thoughts – Narusan Nov 10 '17 at 16:41
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What do you think of the scope?

It's a mess. Personally, I'd exclude food sciences because the issue is so debatable and I haven't seen any good question about food sciences. It is important to remember that a SE site for every single topic is not mandated, we could cut out stuff that is irrelevant.

Furthermore, CogSci has a close reason for "not framed in cognitive sciences". This basically allows any non-expert, hypothetical, badly researched question to be closed as off-topic. In my opinion, it would be good to have this on Health.SE (or whatever name we give it). I think that the following questions should not be considered as good questions here:

  • Is X healthy?
  • What are cures for X? (where X is a symptom and not an illness)
  • Recommendation of treatment options, diagnosis etc.

What do you think of the site name?

It's a mess, and we can't even blame users who ask personalised questions because on a site called Health, one would expect such questions. I seriously think that the biggest improvement that could be made to the site is renaming it. I personally like MedicalSciences.SE a lot, but I'm open to other suggestions.

While we're at it - We should rename our main chatroom as well. As I outlined below, low activity in chat is another problem we are facing, and The Waiting Room, despite being very fitting for the site, also invites patients to go there wait for a doctor to show up and ask all the "diagnose me" questions in comments.

What do you think of the site moderation?

I appreciate our moderators and I do think that they do a good job, but I fear that because of the current amount of bad questions, they are likely to be burned out pretty soon.

What do you think of how we handle the need of references?

On the one hand, the inclusion of references has lead to good quality of answers (but huge efforts of posting answers). I think that if we have enough health professionals and questions are high quality, references could become essentially obsolete because a lot of users could verify claims themselves. I'd personally drop it from "required" to "encouraged" if we do make my proposed transition.

Which aspects of Health.SE are working well?

  • The quality of good answers!
    If answers do follow site guidelines, we end up with a lot of really really great answers that could be turned into textbooks. To me, this is a sign that our measures do lead to an improvement of quality.
  • That's about it, to be honest.

Which aspects of Health.SE should be improved, and how?

  • More Activity on Chat
    Most of us have busy schedules, but it would be great if chat could be more active. This benefits new users who just want to learn how to use our site and have small questions, and it benefits veteran users for questions/exchanges not suited for the Q&A format.
    Solution:
    We could organise monthly events around a time when people are usually available. One event I'd personally be looking forward to a lot is discussing studies. Maybe someone could pick an interesting study and prepare a bit for the next month where we discuss the importance, limitations and implications of the study. At the end of the event, we'd agree on someone else who will prepare for the next month. This exchange could also be combined with stories and gossip from work and tips how to do things given some users huge experience.
  • More questions asked by professionals
    There are questions asked by professionals, but they usually suffocate in the mess of bad questions.
    Solution:
    Alter Scope, Rename Site

The 5 Step Plan Towards A Better Site

  1. Define a new scope
  2. Create new close reasons according to the scope
  3. Update the help pages
  4. Rename the site
  5. Have a few weeks of super strong moderation

Optional Bonus

  1. Create Monthly Chat Events
  2. Advertise the Site on other sites via Community Ads
  • I agree on food science. It should be off topic because the cooking exchange already covers food safety and nutrition. Also agree on site name. The name is 90% of the problem. Ditto on citations. Please, I have to find a citation that says drinking cyanide is bad for you? A large number of medical professionals have been driven away by that one. – Carey Gregory Nov 18 '17 at 5:37
  • But chat events, monthly or otherwise? Nein. – Carey Gregory Nov 18 '17 at 5:38
  • @CareyGregory Sure, the chat events are just bonuses if we should get enough participants for that. – Narusan Nov 18 '17 at 7:59
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    +1 for "Encouraged but Not Required" references. A tussle around requiring references for something that is both proving a negative and widely known in the field is one of the things that just made me give up the site as too much work for too little payoff. – Fomite Dec 19 '17 at 21:23
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    I prefer to offer an answer in a comment rather than spend time on looking for a reference. Yes I know, bad form. – Graham Chiu Jan 23 '18 at 8:45
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I agree with most of the points made. So here are my thoughts,

Mostly on improvements

  • getting rid of unspecific, non-researched, not-thought-through questions

I think that "bad" questions" are plaguing the site and weeding them out would be a major improvement. My suggestion would be to introduce something like a "no research" close reason to the list and then close relentlessly questions lacking research (asker's attempt to answer). This would most likely mean that we would need to put the site into a coma before we can revive it. It is a gamble and we would need a strong base of committed users to see the site through this time. I am ambivalent about the mandatory references in questions (perhaps slightly more in favour than against), but if we would require those, I would accept any reference as a proof of research, not only the scientific ones. As an example, ELL community has discussed a similar problem on their Meta: Details please and came up with a new close-vote reason as a solution. We would, of course, need to word ours differently, since a call for including details would bring a flood of (unwanted) personal medical history details in questions.

  • bigger community of professionals & advertising

I fully support advertising on other SE sites (if we already aren't) - primarily Biology SE, Chemistry SE, and, if we can advertise on sites still in beta, Bioinformatics SE and Cognitive Sciences SE. Other than that I don't have ideas on increasing our community, aside from professionals personally inviting their colleagues, but I have tried this and so has Atl LED if I'm not mistaken, and this goes rather slowly and inefficiently.

  • more questions from professionals

Sure, but they need to be answered. Two of mine sit without a good answer (one with a removed spam and a personal experience/opinion the other one without even an attempt of an answer).

P.S. The mods are doing an enormous job, they are doing it quite well and I feel for them. The community needs to chip in more, by flagging, reviewing and voting. The mod team could probably use more people to take some of the burden off of the current members, but I personally cannot commit to offer such help.

4

Which aspects of Health.SE are working well?

The team work results of different users coming with different backgrounds, expectations, opinions etc. That works quite well, when it's working, but is suffering from very low t-cell count – or how to put it?

Lately it was really good to read 'competing' answers together!

Which aspects of Health.SE should be improved, and how?

We already put on the agenda:

  • attracting new users, new regulars
  • re-activating some of the veterans
  • keeping new users around for long enough to vote (and accept, if applicable)
    for that we need more mandatory reading before posting, up-to-date help and tour (the unicorn-problem)
  • problems with posts from new users should have a very friendly but firm guidance text attached to comments or banners. Encouraging to learn and improve.
  • I know and usually am full of favour for SE guidelines accepting quasi-anon posts. For this site I see this as a major problem, for now at least, I have no solution for.
  • I don't have the slightest idea how this would work for mobile site versions on small screens but the info-banners appearing above 'new post'-boxes need expansion and links?

How to nudge those people into this direction? Expand the regular and active users base. We just need more good answers. After achieving a diverse and "interesting question"-looking default page, perhaps land a few Hot Network Questions. (That is often not really wanted on many sites by quite a few people but seems to have done wonders to the knowledge of vaping.)

What do you think of the site name?

"MedicalOverflow" is a bit funny, Health was deemed too much of a pest attractor; MedicineMans or "Sons of Hippokrates" or something like that would be even worse? If the second site should be still kept alive as an idea, we shoud keep it? Problems with misconceptions and wrong, or better: unwanted, expectations are not derived from names alone. We should focus on users, behaviours, processes and content.

What do you think of the site moderation?

Good job done. Too few, not geographically spread out enough. Global site has input coming at unpredictable hours. That alone is demanding unhealthy shift work now… and introduces an unwelcome delay sometimes.

What do you think of how we handle the need of references?

I wrote in permissibility of non medical sources about it.

If we require sources in "answers that are inspired to explain why and how, are long not short" then some sources should be required. Maybe at least one link to reliable sources required, a few more encouraged? That should be ideally judged on the importance, gravity or centrality of the claim that's made.

Knowledge ages, just referring to textbook X now almost mandates to also mention the edition or year of publication. An expert in the field with degrees to show might have an opinion or factoid memorised long ago that is simply not valid knowledge any longer. Without the links to sources it becomes quite terrible to judge the info given.

And basic problems originating from link-outs to consider:

  • mere appeals to authority (recently found a "systematic review" meta-analysis on a "reliable sources" site that was complete garbage ["of 4436 studies meeting our search criteria, we chose to include 36 in our final analysis…"])
  • basic fact-checking and argument analysis in relation to the links given takes time and sometimes extraordinary effort
  • this should not become a primitive link farm
  • quantity and quality are not synonyms

For these basic problems just mentioned a simple guideline would be helpful, but alas, I have none; and I have difficulty imagining one.

Aside from:
Strong claims require strong backup.

What do you think of the scope?

I'm not really sure that the broad scope of all medical concerns is the problem. And I'm not willing to say that we can't handle homeopathic experts, or alternative medicine opinions.

Second that. "Can you treat X with ayurveda/homeopathy?" A: "Naturally, of course, you can treat anything with that! But outcomes will differ… Often quite severely so. And here is why… and this a better solution…"

Currently, I think if the "Diagnose-me" questions stop from appearing then we have made a great step towards a cure for the site.

There is still a certain need to reach a consensus on what does constitute "a bad question" and how to effectively communicate that to people inclined to post a new question. A problem of principle here is that tour and help docs do not reflect much of the attempts in the recent past to salvage the site. I do not know how this works and what's involved to change that, but the lack of change there while we're stuck in all these metas feels like a very frustrating lack of progress.

A closing word regarding quality of questions in regard to answers:

"Bad questions" that are on-topic should be allowed and answered in principle. Improvement encouraged or enforced.

A certain level of general ignorance is to be expected in questions. Cluelessness and bad knowledge or bad advice are abound on the net. This is imho only a problem if this appears in an answer with good standing (many upvotes). To address that we should really encourage sharing prior research in questions, but not necessarily enforce quoting "reliable sources" there.

3

Which aspects of Health.SE are working well?

Honestly, none.

Which aspects of Health.SE should be improved, and how?

I think you're already on track, but I'm concerned that any server side modifications are a pipe dream. I think the #1 need is the quick euthanization of bad questions, hopefully as automated as possible.

What do you think of the site name?

I love the idea of "MedicalOverflow."

What do you think of the site moderation?

The current mods can't be expected to deal with the current deluge of vomit that is the majority of questions asked.

I'm in ID so I'm prone to taking inspiration from viruses. We should accordion up the gene count in the genome until we find mutation that works. I would say increase the size/# of moderators by at least a log.

What do you think of how we handle the need of references?

I've written about this extensively in a previous meta answer, but briefly every single question should be required to have at least one link out or citation. Questions that are kept without proof of research should be the exception not the rule.

What do you think of the scope?

I'm not really sure that the broad scope of all medical concerns is the problem. And I'm not willing to say that we can't handle homeopathic experts, or alternative medicine opinions.

E.g. There's probably some truth to the fact that additional cannabinoids have medicinal value, and those should be brought out and studied at a pharmacological level. I have an answer on the main site somewhere to that effect.

  • Regarding the scope: Do you think questions by laypeople should be encouraged or should some degree of knowledge prior to asking be expected? – Narusan Nov 10 '17 at 18:11
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    @Narusan-sedated Too hard to regulate and define. Requiring one citation is a clear and objective test. No real professional will have a problem providing citations. – Atl LED Nov 10 '17 at 18:13
  • And even to a pro, show me you checked the red book [or insert base field reference here] before you asked the question. – Atl LED Nov 10 '17 at 18:15
  • I didn’t really intend to target the citation. It‘s rather that many bad questions could be deleted if we just have „not enough medical terminology“ as close reason. Like, „cures for grey hair“ is something I don’t like to see, because that’s a symptom, not a diagnosis. – Narusan Nov 10 '17 at 18:17
  • @Narusan-sedated I'm not really on board with requiring jargon either. Take the sample question I put in on Area 51. A lay person could ask "would having a tumor in the adrenal gland lead to a drop in cholesterol" and I think it should still be on topic. – Atl LED Nov 10 '17 at 18:27
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    This is excellent, I ditto most of these points - rather emphatically so. – DoctorWhom Nov 11 '17 at 16:15
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    I agree with most of it except that I think MedicalOverflow is nothing short of a terrible name. I'm a software engineer, so I get it immediately, but I wouldn't expect anyone with a medical background to get it at all. I'm also rather lukewarm on requiring citations in questions. I think the citation requirement in answers is already too strict. Basic facts that don't need supporting citations in a journal article shouldn't be required here either. – Carey Gregory Nov 18 '17 at 5:25
  • @CareyGregory are users required to show that they attempted to answer the question themselves on other sites? We simply have no better way to show it here, then to prove that they did some research. – Atl LED Nov 18 '17 at 12:23
  • Regarding the name, I think almost every Medical Professional will find it funny and enjoyable, and thus will hopefully help recruit people. Anyone who spend any kind of time in medicine will find a great deal of things that "overflow." – Atl LED Nov 18 '17 at 12:24
  • On StackOverflow the rule is simply that they have to show that they made an effort to solve the problem themselves. It doesn't say exactly how they have to show that. It's a judgement call, and if 5 people agree they didn't make an adequate effort, it gets closed. That seems to work well there and I think it would work equally well here. Requiring citations would make a lot of good questions very difficult to ask. – Carey Gregory Nov 18 '17 at 17:11
  • @CareyGregory I categorically disagree. First of all I cannot think of a single question that would be on topic here that couldn't at least show that someone had looked up a term in Wikipedia. Secondly it's clearly not working here, and I don't think it ever would, to try the other way. We can't have code blocks that show what someone tried to hack out themselves, the only thing we can look at is did you try to research the answer to find out for yourself. – Atl LED Nov 18 '17 at 17:14
  • I predict that such a rigid, mindless requirement will be the nail in the coffin. – Carey Gregory Nov 18 '17 at 17:23
  • @CareyGregory In what way is it mindless? I've not heard of a single alternative, objective metric that could be used to determine if a poster attempted to research and answer their own question. I would be happy to consider an alternative. Did you even look at the flowchart I created when I originally proposed this? And it must be understood that I am actively seeking to raise the difficulty of asking a question. I think that it should be more difficult to ask any question on the site and that that is the only way more professional involvement will occur. – Atl LED Nov 18 '17 at 17:28
  • "Every question must have a link or it's off topic." That's a mindless rule. It will result in people adding links that add absolutely nothing to the question, or simply annoy people into not asking at all even though they have a good question. (I think professionals will often fall into that second category.) I think leaving the judgement to the community is how SE works best. It's not hard to tell if a question is trivial and would be answered by the first hit in a google search, and if so it won't be hard to find 5 high-rep users who will vote to close it. – Carey Gregory Nov 18 '17 at 17:41
  • @CareyGregory I do agree with you: Source requirements for askers seem somewhat counterintuitive: We show that questions are not well researched with our downvotes, not with arbitrary close reasons. Also, there is no benefit to listig sources you checked that didn’t yield an answer. Finally, different to SO, we won’t run into problems with „please do my work“, yet for this reason the effort rule has been created. // From my impression of the site, source requirements of answers are a more important matter to discuss. – Narusan Nov 18 '17 at 18:15
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Which aspects of Health.SE are working well?

The fact that there is a Health SE at all is exciting to me. I've never participated in any SE Meta before, but I see a lot of potential in an objective resource that can help people overcome the challenges of the prevalence of "snake-oil", and highly complicated hard-to-navigate healthcare systems.

What do you think of the site moderation?

Having a question voted for closing is a negative experience, especially for users who legitimately put time and effort into their questions. It feels like a slap in the face, even if it's not meant to be. Therefore, I think that the focus of moderation should be on cures, not bandages. Which brings me to...

Which aspects of Health.SE should be improved, and how?

Take a look at the site from the perspective of the naive user.

The front page says, in the middle of a sentence, "...is not intended as a substitute for individualized diagnosis...", which might be inferred to mean that questions about oneself are not welcome, but to most people will sound like standard indemnification jargon.

When I click "Ask a Question", I see "We prefer questions that can be answered, not just discussed. Provide details. Share your research.", and that is the extent of the guidance I am given.

In order to learn that "Personal medical advice questions are off-topic", I need to go as far as to click on the "How to ask" link. This is easy to miss, and even if found, most people will not follow it because who doesn't know how to ask questions?

In order to discover that the extent of what is considered on-topic is limited to

  • Environmental or nutritional factors that affect health
  • The ways that diseases and injuries affect people
  • The health effects of processes such as pregnancy and aging
  • Medications and other interventions that are used to treat diseases

... and does not actually include healthcare professionals, nor healthcare systems, I must peruse the Help Center until I find and read the page What topics can I ask about here?. The Help Center, by the way, is not directly linked to from the home page, except in small text in the footer.

In summary, it could be a lot more obvious to new users that they should not ask the questions that you are having trouble with, and it is no wonder that they keep asking those questions.

A small start could even be to encourage moderators to link to the list of acceptable topics in their close-request-comments.

Edit: It looks like this exact thing is being discussed in Let's open a discussion on building in quality control measures that encourage higher quality posts/answers

What do you think of the site name?

If the scope is to include questions about healthcare professionals and systems, it's perfect. If not, then I don't think the name is the biggest concern.

What do you think of the scope?

I ended up mentioning this in a comment on Questions on health business, a Meta question specifically about whether or not the scope encompasses health business (I hope it's not annoying or inappropriate that I repeat myself to some extent here): I think that a strongly moderated, objective place like Stack Exchange is desperately needed for healthcare topics. Healthcare systems are difficult to navigate. Being systems, they have a lot of objective questions with objective answers.

The topics of nutrition, aging, and disease, on the other hand, I think will more often than not will be impossible to answer objectively, or with significant evidence, unless it is very clear that we're talking about these things at the molecular biology level. Which leads me to ask this question: Who is the target user?

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    Many thx for participating in meta! Very welcome thoughts. Some of your points are in the process of being addressed, as far as that is possible (there are also higher powers, e.g. preventing a really radical redesign – of a beta site above all). There are a lot of posts on the active tab here on meta about trying out the recent ideas. Feel more than only invited to read them as well and participate there also. – LаngLаngС Jan 23 '18 at 16:26

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